Empiric quinidine therapy for asymptomatic Brugada syndrome: time for a prospective registry.

摘要

Our present therapeutic approach to asymptomatic Brugada syndrome is probably causing more harm than good. All over the world, patients with asymptomatic Brugada syndrome are undergoing electrophysiologic studies (EPS); depending on the aggressiveness of the EPS protocol, 20% to 80% of such patients will have inducible ventricular fibrillation (VF), and many will undergo implantation of an implantable cardioverter defibrillator (ICD). However, the rate of spontaneous VF among patients undergoing prophylactic ICD implantation for "asymptomatic Brugada syndrome with inducible VF' seems to be only 1% per year according to a multicenter European study. Accordingly, ICD implantation might be unnecessary for the vast majority of patients. On the other hand, 28% to 32%6 of these young individuals develop very serious complications directly related to ICD implantation. Thus, the wisdom of guiding our therapeutic approach by the results of EPS has been questioned.